Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Analyse de la performance des hôpitaux: les interventions cardio-vasculaires transcutanées

info:eu-repo/semantics/publishe

L'HEPATITE B: CONCEPTIONS ACTUELLES

After a short description of the Hepatitis B virus (HBV), its newly associated antigen-antibody systems are briefly introduced. The natural course of hepatitis is then presented with regard to the evolution of these serological markers, whose clinical significance is discussed. An immune response responsible for the destruction of the HBV infected hepatocytes is proposed and related to the various clinical pictures commonly encountered. Virus transmission, epidemiology and prognosis of hepatitis B are reviewed and also the possibilities of prevention, i.e. passive (specific and non-specific gamma globulins) and active immunization.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

POLYARTHRALGIES ET HEPATITE A HBs Ag

The authors report on a case of hepatitis B to illustrate their review of the present understanding of the immunologic mechanisms inducing cytolysis in hepatitis. The pathogenesis of the immune-complex diseases is recalled: it explains the particular case of articular manifestations accompanying HB(s)Ag hepatitis (characteristics of which are reviewed).SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Marte: A new profile rfp for the modeling and analysis of real-time embedded systems

International audienc

MDA for SoC Design, UML to SystemC Experiment

International audienc

MARTE: a new OMG profile RFP for the Modeling and Analysis of Real-Time Embedded Systems

International audienceA new RFP invitation for an UMLTM profile on Real-Time and Embedded systems modeling and analysis (codename: MARTE) was recently voted at OMG.While of broader scope than strictly SoC design, many objectives of MARTE are highly relevant to the domain (defining time structures, concurrency and communication models, mixing control-flow and dataflow, modeling architectural platforms and adopting Y-chart approaches for allocation of application functions onto architectural resources).We describe the RFP content, stressing its relation to SoC design, as well as others connected activities in the domain, such as SysML, AADL, and UML4SoC